Thorax and Lungs Reference

Normal Breath Sound
Bronchial Breath Sound

Bronchial sounds are loud and high in pitch with a short pause between
inspiration and expiration; expiratory sounds last longer than inspiratory
sounds. These sounds are tubular and hollow-sounding and are usually
heard over the trachea. Bronchial sounds heard over the lung periphery
may indicate complications such as consolidation or cavitation.
Bronchovesicular
● Softer than bronchial sounds
● Active inspiration due to passage of air into bronchi and alveoli
giving vasicular type of inspiratory sound
● However, during expiration, There is increase resistance in the
airway due to spasm causing inspiration to be active and hence
equal or more than inspiration. ● There is no pause between
inspiration and expiration.
● They are best heard in the 1 st and 2ndICS (anterior chest) and
between the scapulae (Posterior Chest)
Vesicular Breathing
It is heard over the thorax, lower pitched and softer than bronchial
breathing. Expiration is shorter and there is no pause between
inspiration and expiration. The intensity of breath sound is higher in
bases in erect position and dependent lung in decubitus position
Pitch – low
Quality – breezy
Amplitude – soft
Duration – long in inspiration, short in expiration
Location – peripheral lung fields
Bronchial sounds are high pitched & usually heard over the trachea. Timing
includes an inspiratory phase that is less than the expiratory phase. If
bronchial sounds are heard in the actual lung fields, this may indicate
consolidation. Vesicular sounds are low pitched, normal breath sounds
heard in the periphery of the lungs, and have an inspiratory phase that is
greater than the expiratory phase. Lastly, bronchovesicular sounds are
medium pitched sounds that have a muffled quality, and the inspiratory
phase is equal to the expiratory phase.
Adventitious Breath Sound
Abnormal Sounds
ADVENTITIOUS BREATH SOUNDS
The term “adventitious” breath sounds refers to extra or additional sounds

that are heard over normal breath sounds. Sources differ as to the
classification and nomenclature of these sounds, but most examiners
commonly use the following terms to describe adventitious breath sounds.
● crackles (or rales)
● wheezes (or rhonchi)
● pleural friction rubs
Crackles (Fine)
CHARACTERISTICS OF FINE CRACKLES SOUND
High-pitched, short, popping sounds. Heard during inspiration and not
cleared with coughing; sounds are discontinuous and can be
stimulated by rolling a strand of hair between your fingers near your
ear. You can simulate this sound by rolling a strand of hair between
your fingers near your ear, or by moistening your thumb and index
finger and separating them near your ear.
SOURCES OF FINE CRACKLE SOUNDS

Inhaled air suddenly opens the small deflated air passages that are
coated and sticky with exudate.
ASSOCIATED CONDITIONS WITH FINE CRACKLE SOUNDS

Crackles occurring late in inspiration are associated with restrictive
diseases such as pneumonia and congestive heart failure. Crackles
occurring early in inspiration are associated with obstructive disorders
such as bronchitis, asthma or emphysema.
Bronchitis —an inflammation of the lining of your bronchial tubes,
which carry air to and from your lungs. People who have bronchitis
often cough up thickened mucus, which can be discolored
Asthma — a condition in which your airways narrow and swell and
may produce extra mucus.
Emphysema — a lung condition that causes shortness of breath. In
people with emphysema, the air sacs in the lungs (alveoli) are
damaged. Over time, the inner walls of the air sacs weaken and
rupture — creating larger air spaces instead of many small ones.
Coarse crackles (rales)
Crackles are indicative of inflammation or infection of the small bronchi,
bronchioles, and alveoli which can cause increased fluid in the lungs
Coarse crackles are non-continuous, transient sounds that appear during

sudden opening or closing of the respiratory tract. They usually appear at
the end of expirations, but in case of higher intensity they may occur during
both inspirations and expirations. Similarly to fine crackles, they occur in
groups and are represented on spectrograms as series of vertical lines.
They sound similar to snoring and gurgling, and sometimes they are similar
to rhonchi.
are heard during early inspiration and sound harsh or moist. They are
caused by mucous in larger bronchioles, as heard in COPD. ... These
sounds originate in the small airways/alveoli and may be heard in
interstitial pneumonia or pulmonary fibrosis.
Characteristics of coarse crackles:
● Popping characteristic sound that is low-pitched.
● Wet bubbling sound
Coarse crackles are sometimes described as having a “bubbling” sound
quality
● Coarse crackles are discontinuous, brief, popping lung sounds.

Compared to fine crackles they are louder, lower in pitch and last
longer. They have also been described as a bubbling sound. You
can simulate this sound by rolling strands of hair between your
fingers near your ear.
The recommended auscultation position for the stethoscope is the Chest
wall position. For this sound, use stethoscope's Diaphragm.
The recommended patient position is Seated

The optimal position for chest auscultation is sitting in a chair, or on the side of the
bed.
However, the patient's clinical condition and comfort needs to be
considered during the examination and some patients may only
tolerate lying at a 45° angle.
Source/Causes of coarse crackles

Causes include: any source of fluid, or mucous that have built up in
the airways and you hear that crackling sound as the air passes through that
fluid or mucus filled area in the lungs.
It can be heard in all different spots usually in the bases
Coarse crackles can be heard in patients with chronic bronchitis,
bronchiectasis, pneumonia and severe pulmonary edema.
Associated conditions of coarse crackles:
Specific conditions that can cause this condition include:
⮚ Pneumonia
⮚ Pulmonary fibrosis
⮚ Acute Bronchitis
⮚ CHF
⮚ Acute Respiratory Distress Syndrome

Coarse crackles are pathological lung auscultation sounds
characteristic of bronchitis, pulmonary fibrosis, bronchitis, CHF,
and Acute Respiratory Distress Syndrome
Continuous Sounds (Pleural Friction Sounds)
CHARACTERISTICS:
Raspy breath sound, usually grating or creaky. Pleural friction rub is
heard on inspiration and expiration. Produced by rub of inflamed pleural
surfaces. It is a Low Pitched, Grating sound described as the sound
made by treading fresh snow. Can be found in Consolidation, Pulmonary
embolism, Uremia, and other inflammatory conditions. It can be mistaken
from a pericardial rub.
SOURCE:
It is caused by inflammation of the pleural layer of the lungs rubbing
together. Your pleura are two thin layers of tissue that separate your
lungs from your chest cavity. One of these pleura layers is tightly
attached to your lungs, and the other is attached to the lining of your
chest wall. There’s a small fluid-filled space between them known as the
pleural cavity. You may experience pain and a pleural friction rub when
these two layers of tissue become inflamed or if they lose the lubrication
between them. A pleural friction rub may be a symptom of a serious
lung condition.
ASSOCIATED CONDITIONS
Pleurisy – also known as pleuritis, is an inflammation of the pleural
tissues around your lungs. Most common cause by this is through viral
infection which causes a sharp chest pain when breathing.
Serositis – an inflammation of the linings of your lungs. Not just the

lungs but also the heart, and abdominal organs. Autoimmune
conditions like rheumatoid arthritis, inflammatory bowel disease, and
juvenile idiopathic arthritis can lead to serositis. Kidney failure,
infections, and AIDS are among other potential causes.
Wheeze (Sibilant)
Characteristics
High-pitched., musical sounds heard primarily during expiration but
may also be heard during inspiration
A wheeze is high-pitched continuous musical sound, which may
occur during inspiration and/or expiration, due to an obstructive process.
The classic wheeze may be referred to as “sibilant wheeze.” This refers to
the high-pitched whistle-like sound heard during expiration, typically in the
setting of asthma, as air moves through a narrow or obstructed airway
Source
Air passess through constricted passage (caused by swelling, secretion, or
tumor)
Associated Conditions
Sibilant wheezes are often heard in cases of acute asthma or chronic emphysema.
Asthma - is a condition mediated by inflammation. The resulting

physiologic response in the airways is bronchoconstriction and airway
edema. This response is triggered by an irritant, allergen, or infection. As air
moves through these narrowed airways, the primary lung sound is high-
pitched wheeze. Initially the wheezes are expiratory but depending on
confounding factors or worsening clinical symptoms, there may be
inspiratory wheezes, rhonchi or crackles. For testing purposes, however,
expiratory wheezes are associated with asthma.
Chronic emphysema - Emphysema is a type of chronic obstructive

pulmonary disease (COPD). In this condition, the air sacs in the lungs
become damaged and stretched. This results in a chronic cough and
difficulty breathing.
Smoking is the most common cause of emphysema, but other factors can also cause it.
There is currently no cure, but quitting smoking can help improve the outlook

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Normal Breath Sound

Bronchial Breath Sound

Adventitious Breath Sound

ADVENTITIOUS BREATH SOUNDS

The term “adventitious” breath sounds refers to extra or additional sounds

SOURCES OF FINE CRACKLE SOUNDS

ASSOCIATED CONDITIONS WITH FINE CRACKLE SOUNDS

Coarse crackles are non-continuous, transient sounds that appear during

● Coarse crackles are discontinuous, brief, popping lung sounds.

The recommended patient position is Seated

Source/Causes of coarse crackles

⮚ Acute Respiratory Distress Syndrome

Serositis – an inflammation of the linings of your lungs. Not just the

Asthma - is a condition mediated by inflammation. The resulting

Chronic emphysema - Emphysema is a type of chronic obstructive

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